Adoption of Computer Tailored Interventions for Smoking Cessation in General Medical Practices: An Experimental Evaluation Based on the RE-AIM Approach

Background: Although brief physician-delivered advice to stop smoking is both effective and cost-effective, implementation in routine clinical practice is still insufficient. Computer-based interventions emerged as a time saving option that might help to exhaust the potential population impact of the general practice setting. The aim of the present study was to combine measures of efficacy used in clinical trial with other components determining population impact as described in the “Reach, Efficacy – Adoption, Implementation, Maintenance” (RE-AIM) framework developed by Glasgow et al. Method: 151 general medical practices were randomly assigned to one of three intervention programs consisting in the delivery of: (1) brief advice by the practitioner; (2) individually tailored computer-generated letters; or (3) a combination of both interventions. We assessed three dimensions of population impact: (1) adoption, i.e., the rate of practices participating in the program; (2) reach, measured as the number of interventions provided within 7 months; (3) effectiveness, measured as smoking abstinence at 12-months follow-up. Results: Among the practices, 70% adopted the program with no significant differences across study groups. Treatment was provided to 3086 adult smokers. Negative binomial regression analysis revealed that the number of interventions provided was higher in practices allocated to the tailored letter and combination intervention groups by 215% (p < .01) and 127% (p = .02), respectively, compared to the brief advice intervention group. Among the patients who received the combination of both intervention, the odds of point abstinence from smoking was increased by 65% (p = .02) and 32% (p = .01) compared to the brief advice and tailored letters intervention respectively. Comparing the number of abstinent patients at follow-up revealed that the tailored letter and combination interventions were superior to the brief advice intervention. Conclusions: Computer-based interventions alone or in addition to conventional practitioner-delivered advice may ease adoption of smoking cessation brief intervention by general medical practices in tobacco control. Evaluation of the different components determining the population impact revealed that the most relevant improvement can be attributed to “Reach”.